range of motion in my knee [Archive]

jonas2

01-29-2004, 09:58 PM

Hello all, hopefully someone out there can help me a little bit. About 7 years ago I developed a condition call osteochondritis dissecans of the medial femur condyle (spelling?). First it happend in my right knee, had surgery, and then right after recovery it happend in my left knee. My right knee healed perfectly and I have had no problems since the surgery but my left knee has not had the same success. To this day I still do not have the full range of motion with this knee. Whenever I try to flex my leg, i cannot bend it all the way without a bit of pain. It gets very tight and as I said.....hurts. I think this may have to do with some tight ligaments or tendons or scar tissue or some such issue. Does anyone have any suggestions as to what I could do to loosen things up or fix this problem? Any help would be greatly appreciated.

Jonas

rbibbs

01-30-2004, 12:23 AM

Jonas, I'm not familiar with that condition or that surgical procedure, perhaps someone else here is.

Have you gone back to the surgeon for suggestions, and did he give you any post-operative rehab? Beyond that, it may not be possible to restore "full" function, but relaxed motion under no load should make it as good as it's going to get. There's also "sympathetic tension" in associated joints, so full hip and ankle mobility might lessen the localized tension and discomfort. The WW applications have "worked wonders" for joint dysfunctions, and can likely improve what you're experiencing now.

Rick

Coach Ilano

01-30-2004, 10:46 AM

As your doctor may have told you the OCD lesion is sort of like an unhealed "hole" in your bone. Very common. The surgical procedure is to drill around the lesion to stimulate healing. A bit like reinjuring the area in a specific way so that the healing process can get back on the right track.

If the surgery was successful and the lesion has healed (as shown in the x-rays or bone scan followup tests by your doctor), then what you are dealing with is separate from the OCD now.

With that in mind, Rick has given good suggestions. Find a way to slowly take your way into better range of motion from your back on down to your feet. Warrior Wellness is very good for that.

You may also consider visiting a physical therapist for your problem.

Also be a little more specific, and there are a whole bunch of people here that can provide more tailored information for you.

Good luck,
Jarlo

jonas2

01-31-2004, 10:34 PM

From x-rays that I have gotten since the operation, the bone surface is smooth and the lesion was healed. In terms of more specific, could you be more specific? :D I am not quite sure what other info I should be giving you. I do think that the knee flexibility and tightness issue is directly linked to the knee operation since it started right as the condition was discovered and really became apparent after the operation. I mean it could be that I was on crutches for quite awhile before the operation since the condition developed in both knees, my right knee first followed by the left (which is the one with the flexibility issues). I am not quite sure. Thank you for your responses and if there is any other information I could provide please let me know.

Jonas

rbibbs

02-01-2004, 10:17 AM

Jonas, I don't think anyone 'on the internet' can definitively say what's going on with a given condition; real-life physicians have a hard enough time doing it even with CAT scans and MRIs. So this is just a 'theory'.

Pain typically accompanies structural dysfunction, and it modifies neurology. Nobody (well, almost) 'likes' pain, and if moving a structure causes pain, we quickly learn NOT to move that structure.

The structure can be physically repaired, as yours apparently (by the x-rays) was. It is possible for the neurological changes to remain, and we may have to formally un-learn our learned reaction.

Example: Around 1970, a wave threw me head-first into the sand in Hawaii. The impact was sufficient to have knocked me out, except for the knowledge I was in the water and unconsciousness would be fatal. My neck wasn't broken but it was severely sprained. The physical injury probably healed in about 6 months, but during that time, I learned not to move my neck, because it hurt. 30 years later, it was still stiff, and holding it in that fixed position caused other actual physical problems, because joints must move to remain functional. In 2001, I started WW, trying to move my neck. It was virtually impossible at first. It hadn't moved in so long, it had literally forgotten how. In the absence of active prohibitive pathology however, we can re-train these motions, and un-learn the neurology of fearing movement. It still makes noises like crunching a bag of tortilla chips, but it moves in all directions without discomfort.

Again, I can't say with certainty that this is the case with your knee, but I hope it is, and wish you the best exploring recovery of articulation. Please consider buying the WW trilogy videos. A small purchase and 20 minutes a day can make a big difference in your near- and long-term joint mobility.

Rick

Coach Ilano

02-03-2004, 11:58 PM

Rick,

Great stuff, very good advice, wish I said it myself!

In the absence of active prohibitive pathology however, we can re-train these motions, and un-learn the neurology of fearing movement.

Wonderful statement! Exactly what I was trying to get at in my posts!

Jonas,

Again, great advice from Rick. It is what I meant when I stated that the OCD lesion is separate from what you are dealing with. Because it was repaired it is no longer an "active prohibitive pathology". So what you have now is different. You may have alluded to how it progressed yourself when you said it could have been the time on crutches, or order of surgical intervention. And you are right again, you can't exactly be sure. But what you can be sure of is how you feel and what limits you right now.

So, this leads into what I mean by being more specific. The questions I ask my patients always involve finding out specifics about the problem in terms of time, activity, easing of symptoms, and all patterns we can think of.

For example. Is it worse in the morning, afternoon, night? Better after exercise, worse? Is it the same all the time? Anything that eases the symptoms. Worse/Better with walking, stairs, inclines? Is there an exact location (you can point to it with a finger) or is it a general area?

Those kinds of things would be very helpful in addressing your problem. And you will see that approaching it in this way, helps you to figure out what's best for you. And of course, we can all help too :)

The gist of it is, that if we take the time to analyze our motions and the factors that could be affecting our bodies limitations. We can learn to "treat" ourselves. Of course, with the disclaimer of no longer having that "active prohibitive pathology". (I am going to steal that phrase Rick! :wink: )

Hope that helps Jonas!

Jarlo

JasonE

02-04-2004, 11:18 AM

When I had arthroscopic surgery on my right medial meniscus, I had been on crutches for 2 weeks.

I saw my chiropractor a couple of times before and after the surgery to relieve the unusual joint stresses experienced as a result of using crutches and then favoring the right leg.

Just using crutches transfers a lot of workload and tension to the other ankle, knee, and hip, and may cause significant tension in the low back and shoulders. Use of a cane or simply favoring a sore knee will affect the good leg to a lesser degree and may cause a compensating reduction of ROM in the opposite arm.

Because I hadn't yet discovered the joys of ROM exercises or PNF stretching, I turned to Tai Chi. The slow, controlled movements allowed me to safely rebuild the strength and ROM I had lost in about 2 months. On occasion I would see my chiropractor or massage therapist to prevent a buildup of tension in compensating muscle groups so that my recovering muscles could take on more of the workload.

I recovered 100% of my ROM and went on to exceed the level I was at prior to surgery.

I have little doubt that you will be able to do the same if you are willing to put in a bit of time.

jonas2

02-04-2004, 12:08 PM

Well thank you all for your replies. I really appreciate the help. In terms of getting more specific here I go. In terms of what time of day does it get worse, there is no pattern there. Its pretty much the same all day long. If I walk a lot during the day or go for a run, afterwards the tightness is worse, but is usually gone by the next morning. Nothing reallys seems to ease the problem but resting. Stretching can help a little bit but does not get rid of it. I don't know the names of any of these parts but, when i bend my knee, on the lateral side, there is a knob at the end of the shin where it connects with the knee. The pain is centered around that. The rest of the knee is just tight, not painful. I think that about covers it. Thanks again for helping me.

Jonas

rbibbs

02-04-2004, 05:08 PM

If I'm reading this right Jonas (and help me Jarlo and Jason)... the "knob" you're referring to is the proximal end of the fibula, and 'relatively' unrelated to the loadbearing surfaces of the knee joint proper. When it's bothering you, turning your foot in a toes-inward position should exacerbate the discomfort (don't force this of course). The fibula is primarily part of the ankle articulation system. One doctor told me the ankle is the most complex joint in the body, and subject to overuse/strain injury both by virtue of complexity and the load it's under. The strain may not necessarily appear or feel like it's in the ankle.

We're still in "internet diagnosis" mode here, so take none of this as absolute, or substitute for advice from a physician or therapist who has first-hand knowledge of your case. The discomfort you feel in the area of your knee, is most likely coming from misarticulation in your ankle, which "forgot" how to move (a little atrophy, plus sensory-motor amnesia) during the time you weren't bearing load on that leg. Your hip joint will also have adjusted to that misarticulation, as will your lumbar spine. Be sure you're not walking and running with your toes turned inward, that would cumulatively strain the "knob" joint.

The restorative motions are too complex to put into text in usable form, but again, the WW videos would be a great place to start.

Jarlo, no "tm" on that phrase, use it in good health :D . And spot-on about analyzing our own motions and contributing to our own diagnosis and recovery.

Jason, great example of the principle of tension-chains, and that rehab goes beyond just moving the injured/repaired structure.

Rick

jonas2

02-05-2004, 06:24 PM

Hmmm. That whole ankle thing is very interesting and I think there is some merit to that whole idea. I am going to really have to look into how things move around my body but the idea really rings true with me. Thanks again for your help, and don't worry, I won't hold you accountable should my legs fall off due to your advice. :D Thanks again

Jonas

rbibbs

02-05-2004, 08:29 PM

You're very welcome Jonas, let us know about your discoveries and progress. That's not just an idle pleasantry, we all grow together, knowing what works and why.

Rick

Coach Ilano

02-21-2004, 01:21 AM

Jonas,

Well... How goes it?

Rick, again!, was spot on about working your ankle.

Your description reminds me of a patient I had a few years ago. He came in with the prescription "ITB syndrome (iliotibial band)" because of the pain of his lateral side of his knee. (Dangers of Diagnosis! :wink: ) I spent a couple of visits doing some stuff, but one day I had the bright idea of mobilizing the proximal tib-fib joint (that "knob" where you notice your pain). He was all good after that.

Also, had a patient a few months ago, whose only complaint was this "knob" pain and stiffness in full squatting position. We mobilized his ankle (specifically talocrural joint). Good immediate response.

If you haven't tried so as of yet, I would recommend stretching your calf. Both in straight knee and bent knee positions. And working out ankles as per Warrior Wellness.

Hope you are finding what you need.

Jarlo

jonas2

02-21-2004, 11:10 AM

Well things are going better for me. Again thank you guys for all your advice. I actually really started concentrating on what was going on with my body during activities like walking or running and I think I figured out the culprit. I noticed that my left knee is not entirely stable, meaning that the stabilizer muscles around my knee are weak. I noticed that sometimes when i was doing something like walking up stairs, the knee had the tendency to move to one side or the other instead of kind of staying in place (explanation there is a little rough). So I came up with the idea that since the stabilizer muscles around my left knee were weak, the main mover muscles like the quad, and calf were taking up the slack. Now this has probably been going on for few years. That sustained level of tension in the main movers spread outward into the ankle, the thigh, the psoas and then finally the back. So all that being said, I have started not only working out the tension in those muscles, but taking steps to build up the stabilizers so that the root of the problem is fixed. Any ideas or comments?

Jonas

rbibbs

02-22-2004, 01:00 PM

Good news Jonas, sounds like a good plan too. This knee condition, the initial one you had surgery for... what brought it to your attention, to where you went to a surgeon? Pain associated with motion? Along that line... there's a reflex-level shutdown neurology, kinda like an electrical fuse, when a muscle contraction produces acute discomfort, the drive-signal to that muscle is inhibited, to keep us from damaging ourselves. Nearby muscles which can contract without increasing discomfort will tense appreciably to... like you say... take up the slack. The pain/inhibition cycle gets learned pretty quickly; so now that contraction is inhibited or attenuated ALL the time, and the associated muscle quickly loses tone and neural sensitivity in both data directions... its response to commands, and its kinesthetic feedback.

We can tend to analogize our bodies to a mechanical system we have some tangible familiarity with, like a car... battery won't charge, get a new fan belt, good as ever = knee hurts, get surgery, good as ever. There's that pesky "adaptability-for-survival" thing working on us though. Battery won't charge, car won't start... it just gives up when almost anything goes wrong. Knee hurts, we hobble, shift loads, contort our skeletons and neurology to accomodate the failure. Knee gets fixed, then to a greater-or-lesser extent, we have to un-learn the adaptations that got us through the crisis. I think that's the stage you're in Jonas, and just having identified the problem is about 2/3 of the solution; patience/diligence/process is the rest. I think you'll be good as ever, before too long.

Rick

jonas2

02-22-2004, 08:53 PM

Sounds good. As far as what made me notice it, well my right knee shut down and was the size of a basketball after waking up one day. That lead me to believe that all was not right in wonderland. Went to the doctor, got it xrayed and diagnosed and there you go. It turns out a piece of bone had actually splintered off and floated into the joint space. While i was on crutches recovering, i started noticing pain in my left knee. They xrayed it all and discovered teh same thing in the left. That again led to surgery. After that, the right knee healed just fine, the left knee never really got it back which leads me to present day. Thanks again for the advice, and as things progress I will update you guys. Oh and if you think of anything else I can to to help fix it, please let me know.

Jonas

Coach Ilano

02-28-2004, 05:28 PM

Your analysis of your problem was exactly what I hoped you would find! You did a great job of exploring your movements, and seeking the causative factors. Much better, than anything we could come up with on the internet.

You are definitely on the right track, keep working through what you are doing and you should see results.

I always tell my patients that within two weeks of working on a particular plan, they should start feeling "better". Maybe not 100 percent better (but possibly depending on the particular issue and its chronicity), but better enough to notice it and feel that you are on the right track. I say two weeks based on my experiences, but also because it is slightly grounded in the tissue healing process. The acute stage of tissue healing/inflammatory process usually ends in about a week (give or take a couple of days), you then should progess through the cycle to full healing. With repetitive stress disorders, you can imagine that this part of the cycle repeats itself because you cause stress daily to keep it viciously repeating. If you find a way out of it, then your body begins to heal. Thus approximately 2 weeks. Again dependent upon severity and chronicity of the problem.

Great job Jonas!

jonas2

02-28-2004, 06:40 PM

Well, I have started doing teh Warrior Wellness beginner stage stuff and things are feeling good all over. My knee feels better my back feels better and so on and so on. This is all very cool and I have to thank you guys again for your help thus far.

Jonas

jonas2

04-13-2004, 11:06 AM

So I figured I would update this again since I have found even more stuff going on. Over the past 2 weeks I have noticed that my left ankle is also stiff...but not overly so. I noticed that it is stiff when i try to twist it away from my other leg, on a level plane (if that makes sense). My martial arts teacher tried to some sotai on it and when i was able to increase the range of motion in my ankle that way, the range of motion in my knee increased. All very cool stuff. It still blows my mind that everything can be so connected.

Jonas

rbibbs

04-13-2004, 11:29 AM

Great progress and discoveries Jonas! Glad to hear it.

Yeh mate, you can stub your big toe real good and end up with a crick in your neck (or vice-versa, I've done both).

JasonE

04-13-2004, 11:40 AM

It still blows my mind that everything can be so connected.

Reminds me of an old children's song:

The foot bone is connected to the... ankle bone!
The ankle bone is connected to the... shin bone!
The shin bone is connected to the... knee bone!
The knee bone is connected to the... thigh bone!
The thigh bone is connected to the... hip bone!
The hip bone is connected to the... back bone!
The back bone is connected to the... rib bone!
The rib bone is connected to the... shoulder bone!
The shoulder bone is connected to the... arm bone!
The arm bone is connected to the... elbow bone!
The elbow bone is connected to the... forearm bone!
The forearm bone is connected to the... wrist bone!
The wrist bone is connected to the... hand bone!
The shoulder bone is connected to the... neck bone!
The neck bone is connected to the... HEAD BONE!

Anatomically oversimplified, but there's a lot of fundamental truth in this song's emphasis on the interconnection between all our body's parts. Easily grasped, and easily forgotten. :lol: